P-975. Pharmacist Led Vancomycin Dose Optimization at a Tertiary Care Hospital in Addis Ababa, Ethiopia

TL;DR

This study shows how pharmacist-led dosing of vancomycin improves treatment in a hospital in Ethiopia, where standard dosing is often used.

Contribution

It is one of the first studies to evaluate pharmacist-led vancomycin dosing in African populations.

Findings

Pharmacists made 129 dosing recommendations, with 51.2% accepted by physicians.

The most accepted dosing regimens were 750mg twice daily and 1g once daily.

The study supports wider use of pharmacist-driven dosing in African healthcare settings.

Abstract

Patient-specific vancomycin dosing is paramount to achieving clinical success and reducing toxicity. While pharmacist-guided dosing is utilized in many parts of the world, evidence supporting this practice in African populations is lacking. This study is one of the first interventional studies to assess the impact of pharmacist led Vancomycin dosing among Black communities throughout Africa.Figure 1.Indications for Vancomycin TherapyHAP = hospital acquired pneumonia, SCAP = severe community acquired pneumonia, HAI = healthcare associated infectionTable 1.Accepted Clinical Pharmacist InterventionsAKI = acute kidney injury

Indications for Vancomycin Therapy

HAP = hospital acquired pneumonia, SCAP = severe community acquired pneumonia, HAI = healthcare associated infection

Accepted Clinical Pharmacist Interventions

AKI = acute kidney injury

This prospective interventional study was conducted at Black Lion Hospital, a tertiary care teaching hospital in Addis Ababa, Ethiopia. Pharmacists implemented a vancomycin nomogram for patients admitted to the internal medicine and emergency wards from June 2024 to April 2025. Patients were followed for the entire vancomycin course with adjustments made as necessary.

Pre-implementation most patients received vancomycin at a fixed dose of 1g every 12 hours. Patients with chronic kidney disease or acute kidney injury (AKI), received 1g every 72hr. Post- implementation clinical pharmacists recommended loading and maintenance doses as well as assessed indications, duration of therapy, de-escalation opportunities, and concomitant nephrotoxic medications.

The percentage of physician acceptance of pharmacists’ recommendations was recorded as part of the evaluation.Figure 2.Percentage of Accepted Nomogram Dosing

Percentage of Accepted Nomogram Dosing

A total of 144 patients received vancomycin with sepsis/septic shock the most common indication (Figure 1). The mean duration of therapy was 10.7 days. Concomitant nephrotoxic drugs were used in 60.5% of the patients.

Clinical pharmacists made 129 recommendations, of which 78 (51.2%) were accepted. The most common interventions were discontinuation (41%) and decrease of maintenance dose (37.1%) (Table 1). The most accepted dosing regimens were 750mg twice daily (25.3%) and 1g once daily (10%) (Figure3). Recommendations for de-escalation and loading doses were accepted in 10.2% and 11.5% of cases, respectively.

Our findings have significant ramifications for clinical practice, especially in African healthcare settings where established dosing procedures are frequently lacking and empirical vancomycin use is widespread. These findings support wider implementation of pharmacist-driven dosing and optimization strategies.

All Authors: No reported disclosures

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